Friday, March 12, 1999 Published at 04:01 GMTHealthOsteoporosis treatment set for overhaulOsteoporosis causes brittle bonesNHS managers are to be issued with guidelines on how to prevent and treat osteoporosis, a disease which threatens to overwhelm the health service.

The Royal College of Physicians, which drew up the guidance, has rejected the setting up of a national screening programme, concluding that while the NHS should acknowledge the disease as a significant public health issue, the cost of mass population screening could not be justified.

Instead the college said resources should be targeted at those most at risk.

Osteoporosis, or brittle bone disease, affects approximately 40% of women over 70 years of age, causing severe pain and disability to individual sufferers.

It causes more than 200,000 fractures each year at a cost to the NHS of more than £940m.

More than a third of adult women will sustain one or more osteoporotic fractures in their lifetime.

Men are also at risk from osteoporosis and the ageing of the UK population means that the number of fractures will double in 50 years if changes are not made in present practice.

It is thought the disease may also be caused by the increasingly sedentary lifestyle of the population as a whole.

The new guidelines have been produced by the RCP at the request of the Department of Health. It is concerned that, in the absence of a best practice guide, local treatment strategies varied greatly.

The guidelines were drafted by a small expert group, who consulted widely with experts in the field.

They identify the following points:

The use of bone density assessment in selected individual patients is important in reducing the prevalence of osteoporosis prevention and especially making fractures less likely

Those who would benefit most from bone density assessment include women with a premature menopause; women who had failed to have a period for a year or more; people on steroids for an extended period; women who have suffered hip fractures and elderly people with a stoop or loss of height

Mass population screening is not recommended and health authorities should develop local strategies based on the guidelines

Patients at high risk should be encouraged to increase their level of exercise, stop smoking and increase dietary calcium intake

Hormone replacment therapy (HRT) should be tried for women at risk at the time of the menopause, and can be continued for up to 10 years

The risks and benefits of HRT be explained to women at the time of the menopause or later, so that an informed decision can be made concerning its use

Elderly osteoporotic women should be offered vitamin D with calcium

Hip fracture patients should be treated if possible by a dedicated surgical team and should be operated on within 24 hours, if the patient's medical condition permits, in a dedicated orthopaedic operating theatre

Training in osteoporosis for all health professionals likely to deal with the disease.

Improving health

Elderly women are at risk from the disease

Professor David London, former registrar of the Royal College of Physicians and chairman of the group which drew up the new guidance, said it should help to make osteoporosis care more effective.

He said: "If osteoporosis care and prevention is not revamped the prevelance will increase and the cost to the nation will rise, both in financial and social terms.

"This guidance should make an important contribution to the health of the nation by targeting those most at risk."

Linda Edwards, Director of the National Osteoporosis Society (NOS) said: "The launch of this new report provides a real opportunity for all healthcare professionals, working within the many areas of medicine affected by osteoporosis, to obtain the first definitive, evidence-based guide to managing the disease.

"We particularly encourage health authorities and primary care groups to implement the recommendations of the report within their own strategies for osteoporosis."